基于OCTA分析妊娠期高血压患者产后视网膜微循环的变化

目的：利用光学相干断层扫描血管成像技术(OCTA)定量分析产后6mo以上妊娠期高血压综合征(PIH)患者的视网膜微循环变化。

方法：分别测量19例PIH患者、23例正常妊娠女性(HPW)及19例未妊娠女性(CNPW)的屈光度、最佳矫正视力及眼轴长度，并使用OCTA测量三组视乳头及黄斑区血流参数、神经纤维层厚度和脉络膜厚度。所有妊娠患者数据均采集自分娩6mo以后。运用统计软件SPSS20.0，单因素方差分析比较三组间视网膜微循环相关参数的组间差异。

结果：PIH组的黄斑区无灌注区面积(FAZ)明显大于HPW组和CNPW组(均P<0.05)； 三组间的黄斑区各区域视网膜浅层血管密度无差异； PIH组的视乳头各区域浅层血管密度，其中视乳头整层6mm区域、外层、下外侧、鼻外侧高于HPW组和CNPW组； 视神经纤维层平均厚度三组间无差异，但PIH组的视神经颞侧纤维层厚度明显低于HPW组和CNPW组(均P<0.05)； PIH组的黄斑中心区视网膜厚度明显低于HPW和CNPW(均P<0.05)； 中心凹下脉络膜厚度三组间无差异。

结论：PIH患者产后视网膜部分区域血管密度、黄斑中心区厚度及颞侧视神经纤维层厚度与HPW及CNPW组间均存在差异，提示PIH对视网膜微循环的影响可能在产后仍持续存在。

Changes of retinal microcirculation in postnatal patients with pregnancy-induced hypertension based on OCTA

AIM: To quantitatively analyze the changes of retinal microcirculation in patients with pregnancy-induced hypertension(PIH)syndrome who have delivered after more than 6mo by using optical coherence tomography angiography(OCTA).

METHODS: In this study, a total of 19 females with PIH, 23 healthy pregnant women and 19 control non pregnant women(CNPW)were recruited. Ocular examinations including diopter, best corrected visual acuity and axial length were measured, respectively. OCTA was used to measure the optic nerve head and macular blood flow parameters, nerve fiber layer and choroidal thickness of the three groups. The data of pregnant patients were collected more than 6mo after delivery. All statistical analyses were performed in the SPSS20.0, and single factor analysis of variance was used to analyze inter-group differences of retinal microcirculation related parameters among the three groups.

RESULTS: Foveal avascular zone(FAZ)of the PIH group was significantly larger than that of the HPW and CNPW groups(all P<0.05). There was no statistical difference in macular superficial capillary plexus vessel density among the three groups. The superficial capillary plexus vessel density of each region of the optic nerve head in the PIH group, among which the entire 6mm layer, outer layer, lower lateral layer and lateral nasal, was higher than that in the HPW and CNPW groups. There was no statistical difference in the average thickness of retinal nerve fiber layer among the three groups, but the thickness of temporal retinal nerve fiber layer of PIH group was significantly thinner than that of HPW and CNPW group(all P<0.05). The central foveal thickness of PIH group was significantly thinner than that of HPW group and CNPW group(all P<0.05). There was no statistical difference in central choroid thickness among the three groups.

CONCLUSION: Differences were founded in partial retinal superficial capillary plexus vessel density, central foveal thickness and temporal retinal nerve fiber layer thickness in postpartum patients with PIH compared with HPW and CNPW groups, suggesting that the effect of PIH on retinal microcirculation may still exists after delivery.